Provider Demographics
NPI:1255602173
Name:ELLIOTT, SHANNON (QP, BSW, MSW, LCSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:QP, BSW, MSW, LCSW
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:ORLANDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:QP, BSW, MSW, LCSW
Mailing Address - Street 1:5406 ULLOA PL
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2691
Mailing Address - Country:US
Mailing Address - Phone:910-368-1485
Mailing Address - Fax:
Practice Address - Street 1:5406 ULLOA PL
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2691
Practice Address - Country:US
Practice Address - Phone:910-368-1485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0086681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical